Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Psychiatry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
J Korean Med Sci. 2022 Nov 7;37(43):e309. doi: 10.3346/jkms.2022.37.e309.
A considerable proportion of patients warranting total knee arthroplasty (TKA) have night pain, neuropathic pain, and/or depressive disorder, which may not be resolved by TKA. This prospective, longitudinal cohort study aimed to document the prevalence of night pain, neuropathic pain, and depressive disorder in patients with advanced knee osteoarthritis undergoing TKA and to determine whether the specific coexisting pain and/or disorder at the time of TKA adversely affected postoperative outcomes.
In this study, 148 patients undergoing TKA were longitudinally evaluated. The presence of night pain, neuropathic pain (determined using Douleur Neuropathique 4 [DN4]) and depressive disorder (determined using the Patient Health Questionnaire-9 [PHQ-9]) was determined before and 6 weeks, 3 months and 1 year after TKA. In addition, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and EuroQol-5 Dimension (EQ-5D) scores were assessed before and 1 year after TKA. Potential associations of night pain, neuropathic pain, and/or depressive disorder with pre- and postoperative WOMAC and EQ-5D scores were examined in subgroup analyses.
Preoperatively, 72% (n = 106) of patients reported night pain, and the prevalences of neuropathic pain and depressive disorder were 15% and 17%, respectively. Preoperatively, compared with patients without night pain, those with night pain had significantly poorer preoperative WOMAC scores, but no significant difference was seen between groups 1 year after TKA. Preoperatively, the WOMAC, EQ-5D, and EQ-5D health scores of patients with neuropathic pain were not significantly different from those of patients without neuropathic pain, and there was no difference in clinical outcome scores 1 year after TKA between these groups. Preoperatively, the patients with depressive disorder showed significantly poorer preoperative WOMAC, EQ-5D, and EQ-5D health scores than those without depressive disorder, but no significant differences in scores were observed 1 year after TKA between these groups.
This study revealed a considerable prevalence of night pain, neuropathic pain, and depressive disorder in patients undergoing TKA and that patients with these specific conditions reported poorer functional and quality of life scores preoperatively. However, such adverse effects disappeared after TKA. Our study findings suggest that TKA can provide satisfactory outcomes for patients with these specific conditions.
相当一部分需要全膝关节置换术（TKA）的患者存在夜间疼痛、神经病理性疼痛和/或抑郁障碍，这些问题可能无法通过 TKA 解决。本前瞻性、纵向队列研究旨在记录接受 TKA 的晚期膝关节骨关节炎患者夜间疼痛、神经病理性疼痛和抑郁障碍的发生率，并确定 TKA 时是否存在特定的共存疼痛和/或障碍会对术后结果产生不利影响。
本研究对 148 例行 TKA 的患者进行了纵向评估。在 TKA 前、后 6 周、3 个月和 1 年时，使用 Douleur Neuropathique 4（DN4）确定神经病理性疼痛的存在，使用患者健康问卷-9（PHQ-9）确定抑郁障碍的存在。此外，在 TKA 前后评估了西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）和欧洲五维健康量表（EQ-5D）评分。在亚组分析中，检查了夜间疼痛、神经病理性疼痛和/或抑郁障碍与术前和术后 WOMAC 和 EQ-5D 评分的潜在关联。
术前，72%（n=106）的患者报告有夜间疼痛，神经病理性疼痛和抑郁障碍的患病率分别为 15%和 17%。术前，与无夜间疼痛的患者相比，有夜间疼痛的患者的术前 WOMAC 评分明显较差，但 TKA 后 1 年两组之间无显著差异。术前，有神经病理性疼痛的患者的 WOMAC、EQ-5D 和 EQ-5D 健康评分与无神经病理性疼痛的患者无显著差异，TKA 后 1 年两组之间的临床结局评分也无差异。术前，有抑郁障碍的患者的 WOMAC、EQ-5D 和 EQ-5D 健康评分明显差于无抑郁障碍的患者，但 TKA 后 1 年两组之间无显著差异。
本研究揭示了接受 TKA 的患者中存在相当比例的夜间疼痛、神经病理性疼痛和抑郁障碍，这些患者术前的功能和生活质量评分较差。然而，这些不良影响在 TKA 后消失。我们的研究结果表明，TKA 可为这些特定情况的患者提供满意的结果。
